Discharge And Home Healthcare Guidelines

Teach the patient to protect the incision site from thermal, physical, or chemical trauma. Instruct the patient to inspect the incision site for signs of bleeding or infection. Teach the patient to notify the physician for fever or increased redness, swelling, or tenderness around the incision site. Provide instructions as indicated for specific adjuvant therapy: chemotherapy, radiation, immunotherapy.

Teach the patient strategies for prevention and for modifying the risk factors:

Skin self-examination and identification of suspicious lesions: Moles or nevi that change in size, height, color, texture, sensation, or shape; development of a new mole. Limitation of ultraviolet light exposure: Avoid the sun between the hours of 10 a.m. and 3 p.m. when the ultraviolet radiation is the strongest. Wear waterproof sunscreen with a sun protection factor of greater than 15 before going outdoors. Apply sunscreen on cloudy days because roughly 70% to 80% of ultraviolet rays can penetrate the clouds. Reapply sunscreen every 2 to 3 hours during long sun exposure. Be aware that the sun's rays are reflected by such surfaces as concrete, snow, sand, and water, thereby increasing exposure to ultraviolet rays. Wear protective clothing when outdoors, particularly a wide-brimmed hat to protect the face, scalp, and neck area. Wear wrap-around sunglasses with 99% to 100% ultraviolet absorption to protect the eyes and the skin area around the eyes. Be aware of medications and cosmetics that increase the sensitivity to ultraviolet rays. Minimize ultraviolet exposure as much as possible and use sunscreen that contains benzophenones. Avoid tanning booths or sunlamps.


DRG Category: 020

Mean LOS: 8.2 days

Description: MEDICAL: Nervous System Infection

Except Viral Meningitis

DRG Category: 021

Mean LOS: 8.4 days

Description: MEDICAL: Viral Meningitis

M eningitis is an acute or subacute inflammation of the meninges (lining of the brain and spinal cord). The bacterial or viral pathogens responsible for meningitis usually come from another site, such as those that lead to an upper respiratory infection, sinusitis, or mumps. The organisms can also enter the meninges through open wounds. Bacterial meningitis is considered a medical emergency because the outcome depends on the interval between the onset of disease and the initiation of antimicrobial therapy. In contrast, the viral form of meningitis is sometimes called aseptic or serous meningitis. It is usually self-limiting and, in contrast to the bacterial form, is often described as benign.

In the bacterial form, bacteria enter the meningeal space and elicit an inflammatory response. This process includes the release of a purulent exudate that is spread to other areas of the brain by the cerebrospinal fluid (CSF). If it is left untreated, the CFS becomes thick and blocks the normal circulation of the CFS, which may lead to increased intracranial pressure (ICP) and hydrocephalus. Long-term effects of the illness are predominantly caused by a decreased cerebral blood flow because of increased ICP or toxins related to the infectious exudate. If the infection invades the brain tissue itself, the disease is then classified as encephalitis. Other complications include visual impairment, cranial nerve palsies, deafness, chronic headaches, paralysis, and even coma.

Of the bacteria that cause meningitis, pneumococcal meningitis has the highest rates of mortality at 21%. If severe neurological impairment is seen at the time of initial assessment or very early in the clinical course, the mortality rate is 50% to 90% even when therapy is instituted immediately.

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